Dr Alice Deasy

Healthcare in a prison setting

Spectrum Community Health CIC

by Alice Deasy (Trailblazer GP 2019/20)

I came away from our day with Spectrum Community Health CIC talking about healthcare in a prison buzzing. I was inspired by the people working in this challenging environment, hopeful for what they offered to the often complex and vulnerable individuals who found themselves in those environments, and definitely more informed about what I had thought earlier in the day ‘was another world’. 

Spectrum a not-for-profit organisation established in 2011, provides health services in 13 prison estates in the North of England as well as providing sexual health services and substance misuse services in community settings. 

A basic introduction to the prison estate, categories of prisons and how healthcare in prison operates, was a useful orientation and highlighted the differences between health care in a prison and community setting. Specifically, the contracted healthcare service being ‘the guest of the governor’, and the idea that ‘security came first and health second’. A further difference, was the importance of working with the prison regimen, which might dictate when you had your clinics, how long they might last and when a patient might be available to attend the GP or other clinic. 

The day that gave me hope. I had not considered that for some people prison might provide an environment and an opportunity to stabilise chronic health problems and work with mental health teams to improve underlying mental health problems, and ‘be healthy’. I was reassured by the statement of equivalence, which dictates that the health care in prison should be offered equivalent (but not necessarily the same) as what is offered in the community. However, the point was made that experience in the prison system is not the same for everybody. Overcrowded prisons and a stretched system mean that some people don’t have these opportunities, and difficulties in moving between prisons, uncertainty about future and leaving prison estates at short notice create added challenge. 

The Trailblazers asked questions about the interface between the prison health care system and community general practice. This raised the interesting issue about problems with providing GPs with discharge or ‘release’ paperwork which might facilitate the care of people recently released from prison. We all agreed that improvement in this area would benefit patients.

The day helped me to understand the challenges of the prison context, and the need for excellent MDT working, liaison with the prison services and a bucket load of pragmatism and creative thinking.